Beyond deception: examining the impact of open-label placebos on anxiety and stress

• Applicant: Professor Dr. Sören Enge
• Subject Area: Biological Psychology and Cognitive Neuroscience
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 505631897

Test anxiety, which can have significant psychological, social, and economic consequences, affects up to 40% of all students. Individuals with test anxiety experience extreme distress and anxiety before and in test situations. Strategies against test anxiety include both medication and psychotherapeutic interventions, but it has been shown that placebos can also affect anxiety and stress symptoms. Unfortunately, placebos are given in a decepted way, thereby raising ethical concerns with respect to the patient–healthcare provider relationship. But intriguing new studies demonstrate that placebos can also be effective even if one knows that a placebo was administered. Positive effects of this so-called open placebo administration have been shown in various clinical and subclinical areas such as for chronic pain, depression, or allergies. In a recent pilot study with 58 students, we have demonstrated that open-label placebos reduce test anxiety and improve self-management skills. In a second pilot study we found that open-label placebos reduce state anxiety and stress-related salivary cortisol responses depending on interindividual differences linked to placebo belief (N=52). With the following proposal we aim to further examine the way open-label placebos affect test anxiety. In a first study (N =200) we want to replicate the results in a larger sample (1), investigate the effect with more objective parameters (salivary and hair cortisol measurements) in a real-world scenario compared to a control group (2), and also address interindividual differences in personality (3). In a second study (N = 136) we aim to examine the neural underpinnings of the open-label placebo effect. Therefore, for the first time we are planning to investigate effects of open-label placebos on acute stress by employing functional magnetic resonance imaging (fMRI). The results will help to shed light on important underpinnings and practical implications of open-label placebos.

• DFG Programme: Research Grants